Utility of myoglobin in the evaluation of chest pain in the ED.
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Adult↗
Biomedical subjects
J Woo
Publications and source records attributed to J Woo.
Influence of educational level and marital status on dietary intake, obesity and other cardiovascular risk factors in a Hong Kong Chinese population.
OBJECTIVES: To examine the influence of education and marital status on dietary intake, body mass index, waist hip ratio, blood pressure, fasting and 2 h glucose, and lipid profile in adult Hong Kong Chinese. DESIGN: Randomized age and sex stratified survey. SUBJECTS: One thousand and ten subjects aged 25-74 y (500 men, 510 women) recruited for the 1995-96 Hong Kong Dietary and Cardiovascular Risk Prevalence Survey. MEASUREMENTS: Dietary intake was estimated using a food frequency method. Information on education level and marital status was included in the questionnaire. Anthropometry and biochemical parameters were measured using standard methods. RESULTS: After adjustment for age, higher levels of education are associated with higher percentage protein intake in men, higher percentage fat intake in women, higher nutrient density of fibre and calcium in both men and women, and higher nutrient density of protein, fat, niacin, vitamin D, and polyunsaturated fatty acid in women. Consumption of fruits was also higher in women, and that of dairy products higher in men. Body mass index and waist-hip ratio were lower with increasing levels of education in women, while lower mean systolic BP was observed in men. Single women had lower nutrient densities of vitamin D and iron, and lower consumption of vegetables and fish, compared with married women. Body mass index was lower in both single men and women. Single men had a better cardiovascular risk factor profile, in that diastolic BP, triglycerides and cholesterol/HDL ratio were lower, in addition to a lower body mass index. CONCLUSION: Higher education level is associated with a healthier diet and lower prevalence of overweight.
Adult↗
Prediction of hypertension, diabetes, dyslipidaemia or albuminuria using simple anthropometric indexes in Hong Kong Chinese.
OBJECTIVE: It is important to determine what values of simple anthropometric measurements are associated with the presence of adverse cardiovascular risk factors such as diabetes or hypertension to provide an indication for further detailed investigations. In this analysis, we aimed to assess which anthropometric cutoff values are best at predicting the likelihood of diabetes, hypertension, dyslipidaemia and albuminuria in Hong Kong Chinese. DESIGN AND SETTING: The data were obtained from a previously reported prevalence survey for glucose intolerance in a representative Hong Kong Chinese working population. SUBJECTS: 1513 subjects (910 men and 603 women) with mean age+/-s.d. 37.5+/-9.2 y. MEASUREMENTS: We examined the likelihood ratios of having diabetes, hypertension, dyslipidaemia and albuminuria in subjects with various cutoff values of the four simple anthropometric indexes, namely, body mass index, waist-hip ratio, waist circumference and the ratio of waist-to-height. RESULTS: We developed a nomogram to show the predictive values of different indexes for the cardiovascular risk factors using likelihood ratio analysis. Using Caucasian mean levels of the simple anthropometric indexes to predict diabetes or hypertension in Hong Kong Chinese gave a high likelihood ratio of 2:3:5. CONCLUSION: Higher levels of body mass index, waist-hip ratio, waist circumference and the ratio of waist-to-height are associated with risk of having diabetes mellitus or hypertension in Hong Kong Chinese as in Caucasians. However, the cutoff values of those anthropometric indexes to define obesity used in Caucasians may not be applicable to Chinese.
Adult↗
Smoking and mortality in an older Chinese cohort.
OBJECTIVES: Only limited data are available regarding smoking and health in later life and, in particular, in the older Chinese population. This paper reports the relationship between smoking and mortality in a Chinese cohort aged 70 years and older. SETTING: A population-based study conducted in Hong Kong. PARTICIPANTS: A cohort comprising 2030 subjects aged 70 and older were assembled in 1991-1992 and followed for 36 months. DESIGN: A prospective cohort study. MEASUREMENTS: Baseline information regarding smoking status as well as several social and health variables were obtained through face-to-face interview at the respondent's place of residence. The outcome variables were mortality from all causes as well as from cancer and cardiovascular and respiratory diseases. Causes of death were ascertained from death certificates. RESULTS: The prevalence rates of smoking at baseline were 24.9% in men and 8.2% in women. A total of 534 deaths occurred during the 36-month follow-up period. Of these, 447 were attributable to three main causes: cancer, cardiovascular disease, and respiratory disease. Elevated mortality risks from all causes were observed among both male (RR = 1.4; 95% CI, 0.9-1.9) and female (RR = 1.6; 95% CI, 1.0-2.5) current smokers, but the 95% confidence intervals overlapped. Significant association between current smoking and combined mortality from these three major causes was found in men; it was also found in women after excluding those with these diseases at baseline. More than a 3-fold increased risk of cancer mortality was found in current smokers of both sexes. Although nonsignificant associations were found between former smokers and mortality risks in men, women who were former smokers had increased mortality risks from all causes as well as from cancer and respiratory diseases. CONCLUSIONS: This 3-year prospective study of an older Chinese cohort reveals the impact of smoking on health during later life, especially in women. Smoking cessation, particularly in older men, should be beneficial in reducing mortality. Smoking cessation should begin as early as possible for women.
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Walking speed and stride length predicts 36 months dependency, mortality, and institutionalization in Chinese aged 70 and older.
BACKGROUND: Increasing emphasis is being placed on physical performance measures as an outcome predictor. It is uncertain whether one or two simple measurements will have predictive value compared with a battery of tests. OBJECTIVES: To assess whether simple performance measures such as walking speed and stride length will predict dependency, mortality, and institutionalization. DESIGN: A 3-year longitudinal study of a random sample of subjects. SETTING: Older people living in the community in Hong Kong, Special Administrative Region, China. SUBJECTS: A total of 2032 Chinese subjects aged 70 years and older were recruited territory-wide by proportional random sampling and followed for 3 years. MEASUREMENTS: Functional status was measured using the Barthel Index at baseline and follow-up. The time taken to walk a distance of 16 feet and the number of steps taken were measured at baseline. Stride length is estimated by dividing 16 by the average number of steps needed to complete the walk. Outcomes regarding dependency, mortality, and institutionalization at 36 months were recorded. RESULTS: After excluding subjects lost to follow-up and those who had died, data were available for 559 men and 612 women. Univariate analysis showed that reduced walking speed and stride length were associated with increased risk of dependency, mortality, and institutionalization. In multivariate analysis for dependency and mortality, stride length, walking speed, age, and sex were included in the best prediction model (ROC = 0.798 and 0.707, respectively), whereas only stride length was included in the prediction for institutionalization (ROC = 0.764). CONCLUSIONS: In terms of prevention or modifying outcomes, these two simple performance measures may be used as indicators for checking for occult disease and for interventional measures such as exercise prescription.
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Prospective study of symptom control in 133 cases of palliative care inpatients in Shatin Hospital.
We report a prospective study assessing the prevalence and severity of physical and nonphysical symptoms, and the benefits from treatment and intervention, in advanced cancer patients presenting to a local palliative care unit in Hong Kong. Patients were assessed by a modified version of the support team assessment schedule (STAS). The study highlighted some symptoms which needed better control, and also reinforced the team morale by demonstrating aspects where there was definite improvement. In general, the STAS was found to be practicable and acceptable by our patients and staff. The most important benefit gained from the study was the successful dissemination of the concept of audit and quality assurance throughout the unit, which is essential for continuous improvement in the future.
Adult↗
RDP1258, a new rationally designed immunosuppressive peptide, prolongs allograft survival in rats: analysis of its mechanism of action.
Peptides derived from the HLA class I heavy chain (a.a. 75-84) have been shown to modulate immune responses in vitro and in vivo in a non-allele-restricted fashion. In vivo studies in rodents have demonstrated prolonged allograft survival following peptide therapy. The immunomodulatory effect of these peptides has been correlated with peptide-mediated modulation of heme oxygenase 1 activity (HO-1). Recently, we used a rational approach for designing novel peptides with enhanced immunosuppressant activity. These peptides were also more potent inhibitors of HO-1 activity in vitro. Here we evaluated one of these peptides, RDP1258, for its ability to prolong heterotopic heart graft survival in rats. The peptide mediated effect on HO-1 was analyzed in vitro and in vivo. Peptide RDP1258 was shown to inhibit rat HO-1 in vitro in a dose-dependent fashion. However, RDP1258, like other HO-inhibitors, when administered to rats, secondarily resulted in an up-regulation of splenic HO-1 activity. Up-regulation of HO-1 was associated with prolonged heart allograft survival (6.6 +/- 0.6 vs. 2/14 > 100 days and 12/14 16.2 +/- 1.7 days; p < 0.001). The analysis of graft infiltrating cells on day 5 after transplantation showed a significant decrease in the number of graft infiltrating cells in RDP1258-treated recipients compared to untreated ones (14.8 vs. 32.7%; p < 0.01). In addition, grafts from peptide-treated animals showed significantly decreased expression of TNF-alpha mRNA and increased levels of iNOS mRNA. Our results are consistent with the recent observation that up-regulation of HO-1 results in the inhibition of several immune effector functions. Modulation of HO-1 activity may enable the development of novel immunomodulatory strategies in humans.
Adjuvants, Immunologic↗
Geriatric screening in acute care wards--a novel method of providing care to elderly patients.
OBJECTIVE: To assess a nurse-implemented geriatric screening system. DESIGN: Descriptive study. SETTING: University teaching hospital, Hong Kong. PATIENTS: All (5080) elderly patients admitted between 1 January 1996 and 31 December 1996. MAIN OUTCOME MEASURES: Patient characteristics such as disease, prior admission, living quarters, and regular medications; interventions taken; and morbidity and mortality. RESULTS: The most common interventions were referral to a convalescent hospital, patient education, and carer contact. The overall death rate was 8.5% and the diseases with the highest mortality rates were renal failure, liver cirrhosis, and cancer. Approximately one quarter of patients had been admitted to hospital in the previous month. The death rate was higher among women than men (10.8% versus 6.7%, P<0.001; odds ratio=1.68; 95% confidence interval, 1.38-2.05), as was the percentage of those with a history of admission in the previous month (32.8% versus 20.0%, P<0.001; odds ratio=1.95; 95% confidence interval, 1.71-2.21). Patients with multiple pathologies and polypharmacy had a greater frequency of previous 1-month admission compared with those who did not have these features (37.5% versus 20.0%, P<0.001; odds ratio=2.37; 95% confidence interval 2.0-2.7). Patients living in old-age homes had a higher death rate and more previous 1-month admissions than home dwellers, and patients living in private old-age homes had a higher death rate but lower number of previous 1-month admissions than those living in subsidised old-age homes. CONCLUSIONS: This study has collected important data from one form of integrated geriatric practice, which can be used for future service provision.
Journal Article↗
Low density lipoprotein receptor related protein gene exon 3 polymorphism association with Alzheimer's disease in Chinese.
Since apolipoprotein E4 (apoE4) is the major genetic risk for late onset Alzheimer's disease (AD), proteins that interact with apoE might be involved in AD pathogenesis. Low density lipoprotein receptor related protein (LRP) is an apoE receptor in the brain. In exon 3 of the LRP gene a polymorphism was found to be underrepresented in AD compared to normal Caucasian subjects (N). We examined this polymorphism in Chinese AD and N subjects. The polymorphism frequency in N was roughly half that reported for Caucasians. Compared to N, the frequency was significantly decreased in pathologically diagnosed, but not in clinically diagnosed AD patients. Thus, the role of the LRP exon 3 polymorphism in AD has now been demonstrated in two ethnic groups, suggesting the importance of LRP in AD pathogenesis.
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Characterization and biological significance of immunosuppressive peptide D2702.75-84(E --> V) binding protein. Isolation of heme oxygenase-1.
This is the first report on peptidic inhibitors of heme oxygenase. Such peptides were originally developed from the immunomodulatory peptide 2702.75-84 which corresponds to amino acid residues 75 to 84 of the alpha1-helix of HLA-B2702 (2702.75-84) and has been shown to be immunosuppressive in vitro and in vivo. In vitro, 2702.75-84 inhibited cytotoxic T- and natural killer cell- mediated target cell lysis, and in vivo peptide therapy resulted in prolongation of heart and skin allograft survival in mice. The peptide was also shown to bind to heat shock protein 70. However, D-enantiomers of 2702.75-84 and derivatives thereof, while still being immunosuppressive, did not bind to heat shock protein 70. This study was designed to identify proteins binding to peptide D2702.75-84(E --> V) (rvnlrialry) consisting of D-amino acids. Compared with 2702.75-84 (RENLRIALRY), glutamic acid residue 76 (E) was replaced with valine (V). Affinity chromatography using immobilized D2702.75-84(E --> V) and mouse and human cell extracts, resulted in the isolation of heme oxygenase-1 (HO-1). Peptide D2702.75-84 inhibited HO activity in vitro in a dose dependent manner. Similar to what has been observed with other inhibitors of HO, administration of peptide into mice resulted in an up-regulation of HO-1 mRNA and protein, as well as enzyme activity in liver, spleen and kidney. Other peptides derived from 2702.75-84 with similar immunomodulatory activity displayed similar effects. In contrast, inactive derivatives of 2702.75-84 had no effect on HO activity. Therefore, the immunosuppressive effects of the described immunomodulatory peptides are similar to those of cobalt-protoporphyrin, a known up-regulator of HO-1. Our results suggest that HO-1 modulation may be a novel mechanism of immunomodulation.
Adjuvants, Immunologic↗
No association detected between very-low-density lipoprotein receptor (VLDL-R) and late-onset Alzheimer's disease in Hong Kong Chinese.
The epsilon4 allele of apolipoprotein E (ApoE) is a risk factor in late-onset Alzheimer's disease (AD). As a receptor for ApoE, very-low-density lipoprotein receptor (VLDLR) might be involved in AD pathogenesis. A Japanese study [Okuizimi, K., et al., Nature Genet., 11 (1995) 207-209] has shown an increased 5 and decreased 8 CGG-repeat allele frequency in the 5' untranslated region of VLDLR in Japanese AD versus normal controls (N). Subsequent studies in Caucasian Americans failed to duplicate the result. We examined this polymorphism in pathologically- or clinically-diagnosed Chinese late-onset AD. Our data did not show a significant increase in the 5 CGG-repeat in AD, thus suggesting no association to VLDLR. However, our data did show that the allele frequencies for each CGG-repeat were similar in both Chinese and Japanese.
Age of Onset↗
Glycated haemoglobin and cardiovascular risk factors in Chinese subjects with normal glucose tolerance.
Increased plasma glucose concentration is a predictive factor for mortality in both diabetic and non-diabetic subjects. Although glycated haemoglobin (HbA1c) is a useful index of mean blood glucose concentrations over the preceding 1 to 3 months, there are few data regarding its relationship to cardiovascular risk. We have examined the relationship between HbA1c and cardiovascular risk factors in 1280 subjects with normal glucose tolerance. Based on HbA1c tertiles (tertile 1: n = 427, 262 men and 165 women, HbA1c level: 2.9-4.7% in men and 3.2-4.2% in women; tertile 2: n = 426, 261 men and 165 women, HbA1c level: 4.7-5.1% in men and 4.2-4.6% in women; tertile 3: n = 427, 262 men and 165 women, HbA1c level: 5.1-6.7% in men and 4.6-6.9% in women), increasing HbA1c was associated with increasing age, blood pressure, waist-hip ratio, fasting and 2-h plasma glucose, 2-h insulin, cholesterol, low-density lipoprotein cholesterol, apolipoprotein B and urate concentrations. When age and sex were included as covariates, increasing HbA1c remained associated with increasing fasting and 2-h plasma glucose, 2-h insulin, total cholesterol, and low-density lipoprotein cholesterol concentrations. These findings emphasize the importance of hyperglycaemia, as reflected by HbA1c, as a continuum in the evaluation of cardiovascular risk. Furthermore, these findings support the hypothesis that cardiovascular disease risk commences with rising glucose concentrations before 'conventionally-defined' glucose intolerance occurs.
Adult↗
Randomized trial of the effect of supplementation on the cognitive function of older people with subnormal cobalamin levels.
BACKGROUND: Low serum cobalamin levels are often found in apparently normal older subjects. A major worry of leaving cobalamin deficiency untreated is that it may lead to subtle deterioration in cognitive function. OBJECTIVES: To investigate the effect of supplementation on the cognitive function of older people with cobalamin deficiency by a randomized trial. METHODS: Fifty Chinese subjects more than 60 years old with serum cobalamin level < 120 pmol/l were randomized into supplement and control groups. Fasting serum methylmalonic acid levels (MMA) were measured. A battery of neuropsychological tests was administered. The supplement group received intramuscular cyanocobalamin injections, while the control group received no intervention. They were followed up at around 4 months. RESULTS: 78% of the subjects had raised MMA, indicating metabolic cobalamin deficiency. Supplemented subjects improved in performance IQ, but the amount of improvement was not significantly more than that of control subjects. Moreover, the supplement group fared worse than the control group at follow-up in some motor function scores. Three out of seven demented subjects had improvement in Mini-Mental State Examination scores, but there was no consistent improvement in other neuropsychological scores. CONCLUSIONS: This study suggested that cobalamin deficiency did not invariably cause cognitive impairment in older people. There remain the possibilities that cobalamin deficiency causes cognitive impairment or exacerbates coexisting dementia in some older people.
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Rarity of debrisoquine hydroxylase gene polymorphism in Chinese patients with Parkinson's disease.
Impaired debrisoquine metabolism resulting from defects in the cytochrome P450 CYP2D6-debrisoquine hydroxylase gene has been shown to be associated with the development of Parkinson's disease (PD). We studied two polymorphisms in this gene in 207 Chinese PD patients and 227 control subjects by polymerase chain reaction and restriction analysis. The G to A substitution at position 1934 in the junction of intron 3/exon 4 was detected in one sporadic PD patient and two control subjects, all of whom were heterozygous. The single base deletion at position 2637 in exon 5 was not detected in any of the study subjects. Such rarity of CYP2D6 polymorphism indicates PD in the Chinese population is associated with some other gene defects.
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The health consequences of vertebral deformity in elderly Chinese men and women.
The following health consequences of vertebral deformity in Hong Kong elderly Chinese men and women were studied: the prevalence of back pain, disability due to back pain, and low morale. Lateral X-ray films were taken of the thoracic and lumbar spine of 796 community-dwelling Chinese subjects (396 men, 400 women) (aged 70-79). Subjects with one or more definitely deformed vertebra (reduction in vertebral height 3 SD or more below the mean) were classified as definite cases, those with one or more mildly deformed vertebra (reduction in vertebral height 2-2.99 SD below the mean) as mild cases, and the rest as controls. The prevalence and consequences of back pain were measured by a standardized questionnaire, and morale was measured by the Geriatric Morale Score. The relative risk (RR) and 95% confidence interval (CI) of having back pain and being depressed were calculated by logistic regression. Classifications included 16% of men and 30% of women as definite cases, 37% of men and 35% of women as mild cases, and 47% of men and 35% of women as controls. The relative risk (RR) of back pain was 2.3 (95% CI 1.4-3.9) (P < 0.05) in women with definite deformity and 1.5 (95% CI 0.9-2.5) (P > 0.05) in women with mild deformity, as compared with controls. Sixty-four percent of all men had back pain. This prevalence was much higher than figures obtained in a previous survey on low back pain. The prevalence of back pain did not differ by deformity status, but more men with vertebral deformity were on analgesic. There was no significant association between disability due to back pain and vertebral deformity in women. The RR for having a low morale score (of 5 and below) was 2.3 (95% CI 1.3-4.1) (P < 0. 05) in women with mild deformity; men with vertebral deformity did not have a low morale. It was concluded that vertebral deformity was associated with significant back pain and psychological morbidity in elderly Chinese women. Although men with vertebral deformity did not report more back pain, more were on analgesics than controls.
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Stress protein-induced immunosuppression: inhibition of cellular immune effector functions following overexpression of haem oxygenase (HSP 32).
This is the first report on suppression of immune effector functions following upregulation of heat shock protein 32 (HSP 32), known as haem oxygenase (HO-1). Here we evaluated the effect of cobalt-protoporphyrin (CoPP)-induced HO-1 expression on cell-mediated immune responses. Administration of CoPP to CBA mice resulted in overexpression of HO-1 in the spleen, liver and kidneys. In vitro measurements of T cell-mediated and NK-cell-mediated cytotoxicity in spleens from CoPP-treated animals demonstrated a severe suppression of their effector functions while administration of Zn-PP or vitamin B12 had no effect. Furthermore, CoPP therapy decreased the lymphoproliferative alloresponse and differentiation of cytotoxic T cells. Inhibition of proliferation appeared to be due to cell growth arrest with an increased number of cells staying in G0/G1 phase. Despite the suppressed proliferative response, IL-2 production in the MLR was not inhibited. In contrast, CoPP decreased the production of IL-10, IFN-gamma and TNF-alpha. In vivo, CoPP prolonged the survival of heterotopic heart allografts in mice. The immunosuppressive effects following CoPP-mediated upregulation of HO-1 were similar to those observed after peptide-mediated upregulation of HO-1. The results indicate that overexpression of HO results in the inhibition of several immune effector functions and thus provides an explanation for stress-induced immunosuppression.
Animals↗
Computer-assisted rational design of immunosuppressive compounds.
We describe the rational design of immunosuppressive peptides without relying on information regarding their receptors or mechanisms of action. The design strategy uses a variety of topological and shape descriptors in combination with an analysis of molecular dynamics trajectories for the identification of potential drug candidates. This strategy was applied to the development of immunosuppressive peptides with enhanced potency. The lead compounds were peptides, derived from the heavy chain of HLA class I, that modulate immune responses in vitro and in vivo. In particular, a peptide derived from HLA-B2702, amino acids 75-84 (2702.75-84) prolonged skin and heart allograft survival in mice. The biological activity of the rationally designed peptides was tested in a heterotopic mouse heart allograft model. The molecule predicted to be most potent displayed an immunosuppressive activity approximately 100 times higher than the lead compound.
Animals↗
Bone mineral density in Chinese elderly female vegetarians, vegans, lacto-vegetarians and omnivores.
OBJECTIVES: To compare the bone mineral density and dietary intake of elderly Chinese vegetarian women with omnivores, to compare the bone mineral density of Chinese 'vegans' and 'lactovegetarians', and to study the relationship between nutrient intake and BMD in vegetarians. DESIGN: A cross-sectional survey. SETTING AND SUBJECTS: A community-based study. The vegetarian women (aged 70-89 y) (n = 76) were non-institutionalized subjects. All of them were Buddhists. Their bone mineral density were compared to normal elderly volunteers (aged 70-89 y) (n = 109) who were recruited to establish normal BMD ranges. Their dietary intake was compared to omnivorous subjects from a previous dietary survey (n = 250). METHODS: Dietary assessment was by the 24 h recall method, and bone mineral density was measured by dual-X-ray-densitometry. The analysis of co-variance was used to compare the BMD between vegetarians and omnivores, with adjustment for potential confounders. The BMD in 'vegans' and 'lactovegetarians' were compared by similar methods. The t-test was used to compare dietary intake between omnivores and vegetarians. The relationship between nutrient intake and BMD was studied by correlation and multiple regression. RESULTS: The dietary calorie, protein and fat intake were much lower, but the sodium/creatinine ratio was much higher in vegetarians than omnivores. The BMD at the spine was similar between vegetarians and omnivores. However, the BMD at the hip was significantly lower in vegetarians at some sites (P < 0.05). There was no significant difference in BMD between 'vegans' and 'lactovegetarians'. BMD in vegetarians appeared to be positively correlated with energy, protein and calcium intake; and negatively associated with urinary sodium/creatinine levels. CONCLUSIONS: There is a relationship between diet and BMD. The BMD at the hip was lower in vegetarians than omnivores, but no difference was observed between 'vegans' and 'lactovegetarians'. There is a complex relationship between the intake of various nutrient and BMD in vegetarians.
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